Punto de vista: Más allá de la medicina basada en evidencias
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Viewpoint: Moving beyond evidence-based medicine.
Henry SG, Zaner RM, Dittus RS.
Acad Med. 2007 Mar;82(3):292-7.
Abstract
The evidence-based medicine movement has remained both well known and controversial since its inception. The authors reframe the evidence-basedmedicine debate by pointing out an underappreciated epistemological deficiency: evidence-based medicine as currently conceptualized cannot accommodate concepts that resist quantitative analysis and therefore cannot logically differentiate human beings from complex machines. The authors use Michael Polanyi's philosophy of tacit knowing (which refers to the taken-for-granted knowledge at the periphery of attention that allows persons to understand the world and discern meaning in it) as a starting point for rectifying this deficiency and for working towards an improved, person-centered epistemology of medical practice. The authors demonstrate that not only evidence-based medicine but also most traditional theories of medical practice need a concept such as tacit knowing to account for the kinds of knowledge human beings actually use. Polanyi's philosophy of tacit knowing is defined and briefly explained. A medical epistemology that can account for the tacit dimension of human knowledge and recognize physicians and patients as persons requires a revised conception of medical uncertainty and a recognition that clinician-patient interactions are central to medicine. The authors discuss practical implications of tacit knowing for medical practice, education, research, and health care policy and suggest ways for moving beyond evidence-based medicine towards a comprehensive epistemology of medical practice.
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| Tips para profesores de medicina basada en evidencias |
Tips for teachers of evidence-based medicine: making sense of decision analysis using a decision tree.
Lee A, Joynt GM, Ho AM, Keitz S, McGinn T, Wyer PC; EBM Teaching Scripts Working Group.
J Gen Intern Med. 2009 May;24(5):642-8. doi: 10.1007/s11606-009-0918-8. Epub 2009 Feb 27
Abstract Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinicallearners understand the use and relevance of decision analysis. The first tip demonstrates the structure of a decision tree. With this tree, a clinician may identify the optimal choice among complicated options by calculating probabilities of events and incorporating patient valuations of possible outcomes. The second tip demonstrates how to address uncertainty regarding the estimates used in a decision tree. We field tested the tips twice with interns and senior residents. Teacher preparatory time was approximately 90 minutes. The field test utilized a board and a calculator. Two handouts were prepared. Learners identified the importance of incorporating values into the decision-making process as well as the role of uncertainty. The educational objectives appeared to be reached. These teaching tips introduce clinical learners to decision analysis in a fashion aimed to illustrate principles of clinical reasoning and how patient values can be actively incorporated into complex decision making.
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| Vincular la investigación a la práctica: el aumento de la biblioteconomía en ciencias de la salud basada en la evidencia |
Linking research to practice: the rise of evidence-based health sciences librarianship.
Marshall JG.
J Med Libr Assoc. 2014 Jan;102(1):14-21. doi: 10.3163/1536-5050.102.1.005.
Abstract
PURPOSE: The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. METHODS: FOUR SOURCES OF EVIDENCE ARE USED TO EXAMINE THE RISE OF EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. RESULTS: These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired byevidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. IMPLICATIONS: Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services.
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La medicina basada en la evidencia en la intersección de las líneas de investigación entre los bibliotecarios de ciencias de salud académicos y educadores médicos: una revisión de la literatura
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Evidence-based medicine at the intersection of research interests between academic health sciences librarians and medical educators: a review of the literature.
Dorsch JL, Perry GJ.
J Med Libr Assoc. 2012 Oct;100(4):251-7. doi: 10.3163/1536-5050.100.4.006.
Abstract
OBJECTIVES: In 2008, the Association of Academic Health Sciences Libraries established an Education Research Task Force (ERTF) to plan research addressing research priorities outlined in key Association of American Medical Colleges reports. ERTF members conducted a literaturereview to describe the state of collaborative research at the intersection of medical education and health sciences librarianship. Analysis of initial results revealed instruction in evidence-based medicine (EBM) was a shared interest and is thus the focus of this review. METHODS: Searches on EBM teaching programs were conducted, and results were posted to a shared online citation management service. Individual articles were assessed and assigned metadata describing subject matter, scope, and format. RESULTS: Article analysis identified key themes. Most papers were descriptive narratives of curricular development. Evaluation studies were also prominent and often based on student satisfaction or self-reported competency. A smaller number of controlled studies provide evidence of impacts of librarian involvement in EBM instruction. CONCLUSIONS: Scholarship of EBM instruction is of common interest between medical educators and health sciences librarians. Coauthorship between the groups and distribution of literature points to a productive collaboration. An emerging literature of controlled studies measuring the impact of cross-disciplinary efforts signals continued progress in the arena of EBM instruction.
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